Attachment – Recurring Update Notification - Centers for Medicare ...

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Organ or Disease Oriented Panel Codes Similar to prior years, the 2008 pricing amounts for certain organ or disease panel codes and evocative/suppression test codes were derived by summing the lower of the fee schedule amount or the NLA for each individual test code included in the panel code. The national limitation amount field on the data file is zero-filled. The CPT Editorial Panel created code 80047 Basic metabolic panel (Calcium, ionized) which is an automated multi-channel chemistry (AMCC) code. New code 80047 is comprised of eight component test codes (see below). Also, new code 80047 is not a replacement for code 80048 Basic metabolic panel. Both codes 80048 and 80047 are included in the 2008 clinical laboratory fee schedule. Business requirement 5813.5 provides instructions for payment of new code 80047 effective January 1, 2008. Additional business requirements to update the automated multi-channel chemistry code (AMCC) Panel Payment Algorithm will be issued in a separate instruction with timeframes for implementation. 80047 Basic metabolic panel (Calcium, ionized) • Calcium; ionized (82330) • Carbon dioxide (82374) • Chloride (82435) • Creatinine (82565) • Glucose (82947) • Potassium (84132) • Sodium (84295) • Urea Nitrogen (BUN) (84520) In accordance with the Internet Only Manual 100-04, 40.6.1, the new panel code 80047 cannot be billed for services ordered through an ESRD facility. All tests billed for services ordered through an ESRD facility must be billed individually, not in an organ disease panel. Mapping Information New code 80047 is priced at the same rate as code 80048. Note: Final payment is determined by the automated multi-channel chemistry (AMCC) Panel Payment Algorithm. New code 82310QW is priced at the same rate as code 82310. New code 82565QW is priced at the same rate as code 82565. New code 82610 is priced at the same rate as code 83883. New code 83655QW is priced at the same rate as code 83655. New code 83993 is priced at the same rate as code 83631. New code 84704 is priced at the same rate as code 84702. New code 86356 is priced at the same rate as code 86361. New code 87500 is priced at the same rate as code 87641.
New code 87809 is priced at the same rate as code 87802. New code 89321QW is priced at the same rate as code 89321. New code 89322 is priced at the sum of the rates of codes 89320 and 85007. New code 89331 is priced at the sum of the rates of codes 89320 and 87015. New automated multi-channel chemistry code ATP23 is priced at the same rate as code ATP22. Laboratory Costs Subject to Reasonable Charge Payment in 2008 For outpatients, the following codes are paid under a reasonable charge basis. In accordance with 42 CFR 405.502 – 405.508, the reasonable charge may not exceed the lowest of the actual charge or the customary or prevailing charge for the previous 12-month period ending June 30, updated by the inflation-indexed update. The inflationindexed update is calculated using the change in the applicable Consumer Price Index for the 12-month period ending June 30 of each year as prescribed by §1842(b)(3) of the Act and 42 CFR 405.509(b)(1). The inflationindexed update for year 2008 is 2.7 percent. Manual instructions for determining the reasonable charge payment can be found in Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §80-80.8. If there is insufficient charge data for a code, the instructions permit considering charges for other similar services and price lists. When these services are performed for independent dialysis facility patients, Pub. 100-04, Medicare Claims Processing Manual, Chapter 8, §60.3 instructs that the reasonable charge basis applies. However, when these services are performed for hospital based renal dialysis facility patients, payment is made on a reasonable cost basis. Also, when these services are performed for hospital outpatients, payment is made under the hospital outpatient prospective payment system (OPPS). Blood Products P9010 P9011 P9012 P9016 P9017 P9019 P9020 P9021 P9022 P9023 P9031 P9032 P9033 P9034 P9035 P9036 P9037 P9038 P9039 P9040 P9043 P9044 P9048 P9050 P9051 P9052 P9053 P9054 P9055 P9056 P9057 P9058 P9059 P9060 Also, the following codes should be applied to the blood deductible as instructed in Pub. 100-01, Medicare General Information, Eligibility and Entitlement Manual, chapter 3, §20.5-20.54 (formerly MCM 2455): P9010, P9016, P9021, P9022, P9038, P9039, P9040, P9051, P9054, P9056, P9057, P9058 NOTE: Biologic products not paid on a cost or prospective payment basis are paid based on §1842(o) of the Act. The payment limits based on section 1842(o), including the payment limits for codes P9041 P9043 P9045 P9046 P9047 P9048, should be obtained from the Medicare Part B Drug Pricing Files. Transfusion Medicine 86850 86860 86870 86880 86885 86886 86890 86891 86900 86901 86903 86904 86905 86906 86920 86921 86922 86923 86927 86930 86931 86932 86945 86950 86960 86965 86970 86971 86972 86975 86976 86977 86978 86985 G0267 Reproductive Medicine Procedures
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Attachment – Recurring Update Notification - Centers for Medicare ...

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